Biomechanical Analysis of Hybrid Artificial Discs or Zero-Profile Devices for Treating 1-Level Adjacent Segment Degeneration in ACDF Revision Surgery

Neurospine, 2024 · DOI: https://doi.org/10.14245/ns.2347330.665 · Published: June 1, 2024

Simple Explanation

This study investigates different surgical strategies for revision surgery (RS) following anterior cervical discectomy and fusion (ACDF) to address adjacent segment degeneration (ASD). The focus is on comparing traditional methods with newer approaches like zero-profile (ZOP) devices and cervical disc arthroplasty (CDA). The study uses finite element (FE) models to simulate the biomechanical effects of different revision techniques: cage plus plate (Cage-Cage), ZOP devices (ZOP-Cage), and Bryan discs (CDA-Cage). The goal is to determine which technique minimizes biomechanical stress on adjacent segments, thus reducing the risk of further degeneration and the need for additional surgeries.

Study Duration

Not specified

Participants

30-year-old female

Evidence Level

Not specified

Key Findings

1
The CDA-Cage construct demonstrated the lowest biomechanical responses and ROM ratio at adjacent segments among all RS models, closely approaching or even lower than those in the primary ACDF model.
2
The ZOP-Cage model exhibited lower biomechanical responses compared to the Cage-Cage model, suggesting it's a better alternative when CDA isn't suitable.
3
The CDA-Cage model showed reduced maximum von Mises stress on the C3–4 and C6–7 discs compared to the primary ACDF model, while the Cage-Cage and ZOP-Cage models showed increased stress.

Research Summary

This study uses finite element analysis to compare different surgical revision strategies for adjacent segment degeneration (ASD) following anterior cervical discectomy and fusion (ACDF). The strategies include traditional cage plus plate, zero-profile devices, and cervical disc arthroplasty combined with a cage. The results indicate that the CDA-Cage construct exhibits the most favorable biomechanical profile, reducing stress and range of motion in adjacent segments. ZOP-Cage is a viable alternative when CDA is not suitable. The findings provide a biomechanical basis for surgical decision-making in ACDF revision surgery, aiming to reduce the risk of ASD recurrence. The study suggests hybrid CDA-Cage constructs should be considered when appropriate.

Practical Implications

Surgical Planning

Surgeons can use this biomechanical data to inform their choice of revision surgery technique for ACDF, particularly when considering hybrid approaches.

Reduce ASD Recurrence

The study suggests that CDA-Cage constructs can minimize the risk of adjacent segment degeneration recurrence, potentially leading to better long-term outcomes.

Device Selection

The study provides insight into when ZOP devices may be a superior choice over traditional cage plus plate constructs in ACDF revision surgery.

Study Limitations

1
The cervical spine FE model was generated based on the cervical spine of a single healthy individual
2
Some common cervical degenerative manifestations were not simulated in this study
3
The generalizability of the study’s conclusions to other similar products requires further validation

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